Provider Demographics
NPI:1881463479
Name:KINES, PAMELA DAWN
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:DAWN
Last Name:KINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 OLD MILL FARMS DR # A
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:GA
Mailing Address - Zip Code:30055-3476
Mailing Address - Country:US
Mailing Address - Phone:770-883-8217
Mailing Address - Fax:
Practice Address - Street 1:1050 OLD MILL FARMS DR # A
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:GA
Practice Address - Zip Code:30055-3476
Practice Address - Country:US
Practice Address - Phone:770-883-8217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-25
Last Update Date:2023-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN262546363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care